S&C Team Member Site Safety Observation - 2019

• Safety Observation No.

• Safety Observation Title

• Date Performed

  Date

• Team Member Observed

• Safety Observation Location

• Location
  Address

• Performed by

JOB SPECIFIC INFORMATION AND DOCUMENTATION

• Was a pre-job safety briefing conducted?

  Yes

  No

  N/A

• Has the PSS U.S. Worksite Tailgate Sheet been completed in its entirety?

  Yes

  No

  N/A

• Has the work area been evaluated for hazards, such as, trip/slip hazards and or animal intrusions, etc.?

  Yes

  No

  N/A

• Is there an adequate supply of drinking water?

  Yes

  No

  N/A

• Did the S&C Team Member obtain job site specific emergency evacuation instructions?

  Yes

  No

  N/A

• Did the S&C Team Member attend site-specific safety training, if required by the customer?

  Yes

  No

  N/A

• Does the S&C Team Member have current One Line diagram for the electrical system?

  Yes

  No

  N/A

• Was a Method of Procedure used and followed by the S&C Team Member, if required by the customer?

  Yes

  No

  N/A

• Does the S&C Team Member have access to the S&C Safety Manual?

  Yes

  No

  N/A

• Does the S&C Team Member have access to the SDSs available for the materials brought on site?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT (PPE) INSPECTION

• Does the S&C Team Member have all the PPE required for the tasks and work conditions, including FR clothing, Safety Glasses, Hard hat, FR Safety Vest, EH safety shoes, insulating rubber goods, gloves, sleeves, matts etc.?

  Yes

  No

  N/A

• Is the PPE clothing in good condition? Free of holes, damage and significant wear.

  Yes

  No

  N/A

• Are hard hats and face shields in good condition, free of cracks or significant scratches, and is it stored in a protective bag to prevent damage?<br>

  Yes

  No

  N/A

• Is the S&C Team Member complying with the customer’s PPE requirements, if applicable?

  Yes

  No

  N/A

• Are insulating rubber goods, gloves, sleeves and matts etc., marked with the date they were tested and placed in service? If not, note each item individually in the corrective actions section.

  Yes

  No

  N/A

• Are electrical gloves, sleeves and matts etc. stored in their own bags or container, with leather protectors on, and are not kinked or folded? If not, note each item individually in the corrective actions section.

  Yes

  No

  N/A

• Has the S&C Team Member confirmed that any third party service providers working for S&C are in compliance with our safety requirements? ​ <br>

  Yes

  No

  N/A

ELECTRICAL SAFETY AND LOCK OUT TAG OUT

• Has the S&C Team Member removed all jewelry before starting any electrical work? ​ <br>

  Yes

  No

  N/A

• Has the S&C Team Member erected barricades or used barrier tape to establish work safe zone, if needed?<br><br>

  Yes

  No

  N/A

• Has the S&C Team Member communicated LOTO requirements to the customer, if required?

  Yes

  No

  N/A

• Have all stored energy devices like, capacitors, batteries, springs, charging mechanisms, moving machinery parts, hydraulic systems, etc., been discharged, blocked or released?​

  Yes

  No

  N/A

• Have all the required energy sources, electrical & mechanical, been locked out and tagged?

  Yes

  No

  N/A

• Has all of the equipment in the zone of protection been tested for zero energy using the Live Dead Live method?​​​ <br>

  Yes

  No

  N/A

• Is all testing equipment being used or in the possession of the S&C Team Member calibrated, labeled and has a acceptable calibration date?

  Yes

  No

  N/A

• Are extension cords in good condition?

  Yes

  No

  N/A

• Does the S&C Team Member have, and if necessary are they using, a Ground Fault Circuit Interrupter (GFCI)?

  Yes

  No

  N/A

• Are all insulated tools present in good condition, clean and free of nicks? If not, note each item individually in the corrective actions section.

  Yes

  No

  N/A

FALL PROTECTION

• If the work being performed requires fall protection, is the equipment available, has it been inspected prior to use, and is it being used correctly?

  Yes

  No

  N/A

ERGONOMICS

• Can the S&C Team Member demonstrate proper lifting practices? <br>1. Insure path is clear <br>2. Straight back<br>3. Test weight of unknown object before attempting a lift<br>4. No twisting at the waist<br>5. Lift with legs<br>6. Feet staggered and apart to maintain their stability<br>7. Keep load close to body as possible.<br>

  Yes

  No

  N/A

SAFETY TRAINING VERIFICATION

• If certified in First Aid, CPR, and AED can the S&C Team Member produce the training verification card?

  Yes

  No

  N/A

• If certified in OSHA 10 or 30 hour can the S&C Team Member produce the training verification card?

  Yes

  No

  N/A

SUMMARY OF AUDIT

• MAJOR NON CONFORMANCE - The S&C Team Member was stopped from working and or removed from the job site. Immediate corrective actions are required.

• MINOR NON CONFORMANCE- Critical requirements are being met in order to work safely. Minor issue that require follow up are noted.

• CONFORMING - Meets all requirements and expectations. No follow up required.

FOLLOW-UP ACTIONS - STATE ISSUE, FOLLOW-UP ACTIONS, WHO IS RESPONSIBLE TO CORRECT, AND REQUIRED COMPLETION.

• 1.

  Yes

  No

  N/A

• 2.

  Yes

  No

  N/A

• 3.

  Yes

  No

  N/A

SIGNATURES

• S&C Team Member Signature

  Sign

• Service Manager

  Sign

• Auditor Signature

  Sign